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1 Foundation for Blood Research, Scarborough, ME 04070-0190.
2 Children’s Hospital and Harvard Medical School, Boston, MA 02115.
aAddress correspondence to this author at: Foundation for Blood Research, 69 US Route One, Scarborough, ME 04070-0190. Fax 207-883-1377; e-mail tledue{at}fbr.org.
Background: C-reactive protein (CRP) is a widely recognized indicator of inflammation and is known to play an important role in atherogenesis. Recent prospective studies have demonstrated that increased CRP concentrations within the reference interval are a strong predictor of myocardial infarction, stroke, sudden cardiac death, and peripheral vascular disease in apparently healthy adults. On the basis of available evidence, the American Heart Association and the CDC have issued guidelines for the utility of CRP in the primary prevention of coronary heart disease and in patients with stable coronary disease or acute coronary syndromes. Nevertheless, there remains considerable work to optimize the utility of this marker for risk assessment.
Issues: Most traditional CRP tests designed to monitor acute and chronic inflammation have inadequate sensitivity for risk stratification of coronary disease. Thus, manufacturers have had to develop tests with higher sensitivity. Because an individual’s CRP concentration will be interpreted according to fixed cut-points, issues related to the preanalytic and analytic components of CRP measurement must be considered and standardized where possible to avoid potential misclassification of cardiovascular risk.
Conclusions: Efforts to define performance criteria for high-sensitivity CRP applications coupled with growing awareness of the physiologic aspects of CRP most likely will lead to refinements in standardization, improved performance in quality-assessment schemes, and enhanced risk prediction.
The following articles in journals at HighWire Press have cited this article:
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 L. A. Lange, C. S. Carlson, L. A. Hindorff, E. M. Lange, J. Walston, J. P. Durda, M. Cushman, J. C. Bis, D. Zeng, D. Lin, et al. Association of Polymorphisms in the CRP Gene With Circulating C-Reactive Protein Levels and Cardiovascular Events JAMA, December 13, 2006; 296(22): 2703 - 2711. [Abstract] [Full Text] [PDF]
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 M. A. Albert and P. M Ridker C-Reactive Protein as a Risk Predictor: Do Race/Ethnicity and Gender Make a Difference? Circulation, August 1, 2006; 114(5): e67 - e74. [Full Text] [PDF]
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J. V. Callaghan and S. I. Gutman Counterpoint: food and drug administration guidance for C-reactive protein assays: matching claims with performance data. Clin. Chem., July 1, 2006; 52(7): 1256 - 1257. [Full Text] [PDF]
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R. S. Vasan Biomarkers of Cardiovascular Disease: Molecular Basis and Practical Considerations Circulation, May 16, 2006; 113(19): 2335 - 2362. [Full Text] [PDF]
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B. M. Scirica, D. A. Morrow, S. Verma, S. Devaraj, I. Jialal, B. M. Scirica, D. A. Morrow, S. Verma, S. Devaraj, and I. Jialal The Verdict Is Still Out Circulation, May 2, 2006; 113(17): 2128 - 2151. [Full Text] [PDF]
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 Y. Ma, J. A Griffith, L. Chasan-Taber, B. C Olendzki, E. Jackson, E. J Stanek III, W. Li, S. L Pagoto, A. R Hafner, and I. S Ockene Association between dietary fiber and serum C-reactive protein. Am. J. Clinical Nutrition, April 1, 2006; 83(4): 760 - 766. [Abstract] [Full Text] [PDF]
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S. Kathiresan, M. G. Larson, R. S. Vasan, C.-Y. Guo, P. Gona, J. F. Keaney Jr, P. W.F. Wilson, C. Newton-Cheh, S. L. Musone, A. L. Camargo, et al. Contribution of Clinical Correlates and 13 C-Reactive Protein Gene Polymorphisms to Interindividual Variability in Serum C-Reactive Protein Level Circulation, March 21, 2006; 113(11): 1415 - 1423. [Abstract] [Full Text] [PDF]
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M. Di Napoli, M. Schwaninger, R. Cappelli, E. Ceccarelli, G. Di Gianfilippo, C. Donati, H. C.A. Emsley, S. Forconi, S. J. Hopkins, L. Masotti, et al. Evaluation of C-Reactive Protein Measurement for Assessing the Risk and Prognosis in Ischemic Stroke: A Statement for Health Care Professionals From the CRP Pooling Project Members Stroke, June 1, 2005; 36(6): 1316 - 1329. [Abstract] [Full Text] [PDF]
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 K. F. Hilpert, P. M. Kris-Etherton, and S. G. West Lipid Response to a Low-Fat Diet with or without Soy Is Modified by C-Reactive Protein Status in Moderately Hypercholesterolemic Adults J. Nutr., May 1, 2005; 135(5): 1075 - 1079. [Abstract] [Full Text] [PDF]
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W. L. Roberts CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Laboratory Tests Available to Assess Inflammation--Performance and Standardization: A Background Paper Circulation, December 21, 2004; 110(25): e572 - e576. [Abstract] [Full Text] [PDF]
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P. M Ridker, N. J. Brown, D. E. Vaughan, D. G. Harrison, and J. L. Mehta Established and Emerging Plasma Biomarkers in the Prediction of First Atherothrombotic Events Circulation, June 29, 2004; 109(25_suppl_1): IV-6 - IV-19. [Full Text] [PDF]
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 D. G. Hackam and S. L. Shumak C-reactive protein for the prediction of cardiovascular risk: Ready for prime-time? Can. Med. Assoc. J., May 11, 2004; 170(10): 1563 - 1565. [Full Text] [PDF]
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P. M Ridker and N. Cook Clinical Usefulness of Very High and Very Low Levels of C-Reactive Protein Across the Full Range of Framingham Risk Scores Circulation, April 27, 2004; 109(16): 1955 - 1959. [Abstract] [Full Text] [PDF]
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A. von Eckardstein Is there a need for novel cardiovascular risk factors? Nephrol. Dial. Transplant., April 1, 2004; 19(4): 761 - 765. [Full Text] [PDF]
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